Provider Demographics
NPI:1043506017
Name:OMOTOSO, ADERONKE ARINOLA (B PHARM)
Entity Type:Individual
Prefix:MRS
First Name:ADERONKE
Middle Name:ARINOLA
Last Name:OMOTOSO
Suffix:
Gender:F
Credentials:B PHARM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 CONNELL RD
Mailing Address - Street 2:APT 13C
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-1492
Mailing Address - Country:US
Mailing Address - Phone:229-630-3086
Mailing Address - Fax:
Practice Address - Street 1:2425 N SLAPPEY BLVD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31701-1009
Practice Address - Country:US
Practice Address - Phone:229-883-5047
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-28
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH025908183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist